| Payment ID | 16386 |
|---|---|
| Date Created | 01/28/23 4:18 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 11158 |
| Authorization Number | |
| Applicant Information | |
| Name | Yusimil Herrera |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 01870600887 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Payment Amount | $600.00 |
| Receipt Amount | $600.00 |
| Receipt Date | 01/26/2023 |
| Comments | hotel extension stay at Super 8 departure date is 02/01/23 |
| Receipt | 26-01-2023Herrera600.00.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | DG |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 01/28/2023 |
